CHAPTER 77 DUAL BRONCHODILATORS IN ASTHMA

Nebulized Salbutamol With and Without Ipratropium Bromide in the Treatment of Acute Asthma

Garrett JE, Town GI, Rodwell P, Kelly AM. J Allergy Clin Immunol. 1997;100(2):165–170

BACKGROUND

Asthma has a wide clinical spectrum ranging from mild to life-threatening disease. While deaths due to asthma exacerbation are rare (1/2,000 asthmatics), they have been increasing worldwide. Prior to this study, anticholinergic medications were used in ambulatory and ED settings despite a lack of clinical evidence to support the addition of nebulized ipratropium to beta-agonist nebulizers. Several prior studies had suggested a benefit, but were too small to show statistically significant outcomes.

OBJECTIVES

To determine if single dose ipratropium, in addition to nebulized beta-agonists, improves outcomes for ED patients presenting with acute asthma exacerbation.

METHODS

Double-blind, randomized trial across two EDs in New Zealand.

Participants

Three hundred and thirty-eight patients with acute asthma exacerbation. Mean age for both groups was approximately 29 years old, with approximately 32% active smokers and pulmonary functions tests (PFTs) notable for 39% of predicted FEV₁ in both groups. Select exclusion criteria: >10 pack-year smoking history, “complicating medical diseases” (chronic obstructive pulmonary disease, pneumonia, pneumothorax, congestive heart failure, acute renal insufficiency, or hepatic insufficiency), or pregnant or breast-feeding women.

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